Debunking The REAL Diet Acne Myth

Diet doesn’t cause acne. How often you’ve heard that? For several decades now dermatologists have scoffed at suggestions that diet causes acne and insisted that it’s just a myth. While they believed to be riding the high horse of science, in reality they’ve been cruising with lowly donkey of dogmatism. And now the real myth comes back to bite them on the backside.

Did you know that before the 1960s, dietary advice was part and parcel of acne therapy. Patients were asked to avoid sugary foods. Because studies as early as 1931 suggested that acne patients suffer from blood sugar problems.

Then $(*@ hit the fan.

The diet doesn’t cause acne myth is born

1969 and 1971 saw publishing of two deeply flawed studies that to this day cause misery and suffering to acne patients.

In 1969 Fullerton et al, conducted their now infamous chocolate acne study. They gave 65 people either a daily candy bar with chocolate or a candy bar without chocolate (control). 4 weeks later they measured the difference in rates of acne, and found none. From this they concluded that chocolate doesn’t cause acne.

This study is flawed on some many levels that I doubt even a 7th grade science teacher would accept it. Both of the candy bars were equally high in sugar, fat and calories. The control bar also had plenty of trans-fats, known to increase acne-causing inflammation. All we can say from this study is that one candy bar didn’t cause more acne than the other one.

In 1971 Anderson gave 27 university students, with self-reported dietary acne triggers, either chocolate, milk, roasted peanuts or cola for 1 week. He found no change in acne between the groups. Now, if the 1969 Fullerton et al study was bad, this one is beyond terrible. 1 week is nowhere nearly long enough (most diet-acne studies run for 12 weeks). He didn’t in anyway take into account the other foods the students ate. In scientific terms this study is completely useless.

These two studies are the grand total of scientific evidence that dermatologists have when they say diet doesn’t cause acne. As this 2010 review concludes.

The studies by Fulton et al and Anderson, although suffering from major design flaws, were sufficient to dissociate diet from acne in the minds of most dermatologists. Textbooks were revised to reflect this new academic consensus, and dermatologists took the stance that any mumblings about the association between diet and acne were unscientific and one of the many myths surrounding this ubiquitous disease.

Let me be very clear about that. The notion that diet doesn’t cause acne is not, and has never been, based on science. The fact that dermatologists still repeat it shows how badly out of date they are.

Let’s see just how badly out of date they are.

Studies that link diet to acne

In 2002 Dr. Lorein Cordain did his famous Kitavan study. He studied two groups of native people living in Kitavan Islands in Papua New Guinea and Ache hunter-gatherers in Paraguay. He found zero incidence of acne among these native populations and concluded that acne is a disease of Western civilization.

Another review mentions studies showing increased prevalence of acne when Canadian Inuits and Okinawans in Japan were introduced to Western foods.

Milk and acne

In 2005 Adebamowo et al, tested the idea that milk causes acne. More than 47’000 nurses (data from Nurses Health Study 2) were asked about their high-school dietary intake and whether they had acne. The study found that those how drank the most milk had 22% higher risk of getting acne than those who drank the least milk. The risk was even higher (44%) for those who drank skim-milk.

This study has an obvious problem. Do you remember what you ate last week? Last month? Last year? Dietary recall is obviously less than perfect.

In 2008 the same authors followed up with better studies, a 2006 study with girls and a 2008 study with boys. In both cases they asked the participants to note down what they ate and followed them for 3 years. In both studies high milk intake increased risk of acne by about 20%.

Even a Nestle-sponsored review found several ways milk and dairy products aggravate acne. The paper suggested that if Nestle wants to keep selling boatloads of milk, it better develop dairy products that don’t cause so much acne.

These studies don’t conclusively prove that milk causes acne, but they certainly suggest that drinking milk increases the risk of getting acne.

Sugar and refined carbohydrates

Several studies have looked at the effect of sugar and other high glycemic index (GI) carbohydrates on acne.

I’m not going to bore you by going over all the studies individually. If you are interested, you can find the studies here, here, here, here, and here. And don’t forget about the Korean diet study I wrote about earlier. Pretty much each of these studies took a group of acne patients and either asked them to eat a low glycemic load (LGL) or high glycemic load (HGL) diets. The LGL diets have more protein and focus on whole grains, fruits and other healthy carbohydrates. HGL diets are more normal Western diets that contain more white bread and pasta and other refined (white) carbohydrates.

Here’s a summary of the results:

Acne reduced by 20 – 50% (as measured by total pimple count) in the LGL diet group, which was much better than the HGL group.

Sebum production decreased in the LGL diet group. Sebum composition also shifted towards saturated fatty acids, which is good because they are more resistant to acne-causing inflammatory damage.

With the exception of one, all the studies showed that low glycemic load diets improve acne. In the one negative study both groups had similar total carbohydrate intake, I also wonder how well the teenagers actually stuck to the diet.

Regardless, the majority of the studies show that sugar and refined carbohydrates aggravate acne.

Other bits and pieces

Malaysian study from 2012 compared diets of acne patients to those with healthy skin. They found that acne patients ate more refined carbohydrates, milk and ice cream. And an Italian study from 2012 found that adhering to Mediterranean diet protects against acne.

Diet acne summary

A 2009 review included a handy table that summarizes current diet-acne evidence.

Putting it all together

If I’m being completely honest the evidence for diet causing acne is not rock solid, scientifically speaking. There are still open questions that need answering. But when we are evaluating new claims we should look at 3 things:

Is this claim plausible, meaning does it agree with what we already know in medicine? Yes, it’s very plausible diet causes acne. It doesn’t violate anything we already know about acne formation.

Is there a mechanism for it? Yes, there are many ways diet can cause acne. For example diet affects the levels of hormones that we know are linked to acne.

Does it agree with observations? Yes, several studies now show a link between diet and acne. Not to mention that acne patients have decades and decades kept saying diet aggravates acne.

There’s no question about it anymore. The vast majority of scientific evidence says that diet indeed aggravates acne. The only things going against this are two dingy studies from 4 decades ago.

Diet may not be the be-all-end-all cause and cure for acne, but the view that diet doesn’t affect acne is hopelessly outdated.

33 thoughts on “Debunking The REAL Diet Acne Myth”

I think this info needs to get out more widely. Google searches on diet and acne still bring up a lot of those ‘myths’ articles that are at least 10 years behind on research.

I agree that diet isn’t be-all-end-all thing for acne. I would count it into top 3 or 5 factors behind acne. But I think things like stress, genetics, gut issues, food allergies and sensitivities and topical irritants can be more important. Of course gut issues and food sensitivities are linked to diet, but if I talk about healthy eating in general. That’s why I’m not a big fan of overtly restrictive diets. In most cases balanced, low-sugar diet is enough to make a big difference.

I just have a general acne-diet inquiry. Since different people may have different response to the same acne-inducing food, trial-and-error approach may be necessary (as you also suggest as I recall). My question is, how long do you think would be the response of breakouts after the acne-inducing-food-for-you?

This became relevant when I’ve thought about the trial-and-error approach. For if, say, the response to the specific acne-inducing food is in actuality months delayed, then we might think that what we are eating now are acne-inducing while it is in actuality what we ate months ago, or vice verse, namely, what we are eating now are acne-countering while in actuality is is what we ate months ago and what we are eating are silently building for a grand breakout later.

Perhaps the example is far-fetched but therein lies the point.

The summary question then would be: how long should we try the questioned food during the trial-and-error approach? Weeks or months?

Good question, Humprey! I’m sad to say there’s no simple answer to this and ‘it depends’ – doesn’t it always :)

In some cases you might see quite quick results. For example, when I eat something that irritates my gut I usually see it on my skin a day or two later. Consequently, when I stop those foods it takes only a day or two for new pimples to stop forming and about a week for everything to fade away.

It might take somewhat longer to see the results with milk and dairy. You probably need to wait at least a week or two to see results there.

And finally we have the long-term effects. Say you are insulin resistant and as a consequence break out after eating carbohydrates. Cutting out carbs, or reducing them, can produce fairly quick results – probably in a few weeks, but reversing insulin resistance itself takes several months. And during those months your skin will still be sensitive to carbs.

For if, say, the response to the specific acne-inducing food is in actuality months delayed, then we might think that what we are eating now are acne-inducing while it is in actuality what we ate months ago, or vice verse, namely, what we are eating now are acne-countering while in actuality is is what we ate months ago and what we are eating are silently building for a grand breakout later.

I don’t think it’s like that. More often than not, acne is due to the foods you ate fairly recently, say in the past week or two. Long-term effects are possible, say if you’ve eaten a lot of junk food and sugars. In such a case you may be insulin resistant and have a lot of chronic inflammation going on in your body, both of which can throw off your hormones. Or perhaps you’ve unknowingly eaten foods that damage the gut. All of those can make you more likely to get acne.

So in summary, it can take anywhere from a few days to a few months to see results. If your acne is more hormonal in nature, then you might be looking at the longer end of the range.

I notice on the Elaine Mummery Acne Clinic web site, there is a varied list for the causes of acne that the specialist investigates.In particular I noted the reference to:

1) The type of spots
2) Mineral imbalance e.g. high levels of tin and lead being mentioned

The scientific approach needs to be open minded but I’m not aware of any scientific journals saying that types of spots matter or that tin levels affect acne. This fact being established by hair analysis.
Are you aware of any studies, double binding etc?

I have no idea what she’s doing and thus can’t comment on that specifically. But you are right, there’s no scientific reason to believe ‘type of spots’ you have tells any meaningful information. By now I have read most of the scientific papers dealing with acne (excluding those that compare different prescription treatments) and none of them have ever mentioned that the type or location of spots would have any significance.

The only meaningful difference I know of is separating mild acne patients from those with moderate to severe acne. There is evidence to show people with moderate to severe acne have lower antioxidant levels and more oxidative stress, and as such might benefit from antioxidant supplementation.

I tried searching PubMed on anything published regarding lead and tin in relation to acne. Lead didn’t bring up anything relevant. Ironically, searching for tin, returned several papers dealing with anorexia and eating disorders.. kinda suggestive of what often happens when you follow bad acne advice.

Here’s another mineral imbalance article on the Love vitamin web site. I know the zinc/acne link is well established but what about copper, all of this being based on hair analysis tests? My gut instinct is that there is the potential for vitamin companies to make a killing here based on unverified evidence

Hair mineral analysis is one of those altie diagnostic tools that seems scientific but in reality is anything but, much like their blood tests to diagnose food sensitivities.

I found a few papers from early 2000 that tested commercially available hair mineral analysis laboratories. In these studies they took samples from one or two healthy participants and sent them to several different laboratories. In some cases they even sent several samples from the same subject to each laboratory.

The results weren’t very flattering. There was no consistency between the results from different labs, and the results weren’t just little different – often they were orders of magnitude different. And this is when the labs are testing for the same mineral from the same person!

Here’s the abstract from one of the papers:

Laboratory differences in highest and lowest reported mineral concentrations for the split sample exceeded 10-fold for 12 minerals, and statistically significant (P< .05) extreme values were reported for 14 of the 31 minerals that were analyzed by 3 or more laboratories. Variations also were found in laboratory sample preparation methods and calibration standards. Laboratory designations of normal reference ranges varied greatly, resulting in conflicting classifications (high, normal, or low) of nearly all analyzed minerals. Laboratories also provided conflicting dietary and nutritional supplement recommendations based on their results.
Assessment of commercial laboratories performing hair mineral analysis.

And here’s from the other paper showing what happened when different labs tested the same hair sample several times

Only one lab classified all elements of the first and the second analysis of the identical hair sample in the same category (below, within, or above normal range). The others grouped 4 to 7 elements different.

In other words, the data these labs produce is just noise. Their analysis is not reliable and you can’t use it to conclude anything.

To be honest, a paper published in 2013 showed better results. They took samples from one person and sent it to analysis to 3 different labs, 2 in South Korea and 1 in the US. They also took blood sample to see how the results from the hair sample correlate with blood analysis.

In this study most labs returned comparable results, i.e. there was no statistically significant differences in the values for most of the minerals. There were differences in their analysis of the results. Some labs recommended supplementation because of low levels while others said the same minerals are within normal range.

1 of the 3 labs showed different results when they analyzed the same hair sample twice, while the other two returned consistent results.

It’s hard to say why this paper from 2013 produced different results. Perhaps the analysis techniques have improved in the past 10 years, or perhaps they just used better quality labs.

The bottom line is that there’s very little reason to believe hair analysis produces reliable data. Most likely it’s just one more way altie doctors and vitamin companies get people to buy more useless supplements – as you pointed out.

I went to a doctor for IPL and one of the things she told me was to get on a low glycemic diet. She said she had a lot of diabetics in her practice and put them on a low glycemic index diet. She and her staff could not believe what a difference it made in their skin. Their acne and rosacea both cleared up. She now recommends it for all of her patients.

you know what all these years i’ve always thought diet had something to do with my acne. but i as i get older, i realize that not all of the diet talk is true. for years i tried to avoid wheat, gluten and sugary foods, but i still got acne. i tried to quite coffee and sugar and i still got acne. it seems that no matter what i drink or eat, i would still get acne.

even if i don’t eat anything “bad” i would still get acne. i blamed my acne on so many foods…fruits, vegetables, sugar, coffee, bread and wheat products…chocolate, milk…every thing that isn’t naturally made. guess what? i still got acne.

if i changed my diet into a good one, i’d still get acne, but in tiny forms…like whiteheads and pustules. if i ate something else, i’d get big cysts.

at 24 years old, i sort of gave up on this idea that diet plays a role on my acne. although, i gotta say, i have quite drinking coffee and other beverages besides plain water, not because of my acne, but because of overall health issue like bad breath, dehydration, diabetes…etc.

anyways, at this point, i give up on this diet affects acne. i think it doesn’t necessarily so.

no matter what you eat, if you’re going to break, you’re going to break out. my parents don’t get acne and they eat what i eat. so i don’t see the point.

anyways, what i do now is i take raw garlic, two cloves in the morning, crushed in plain water, and i just drink it down. i eat normal foods and i just drink plain water and avoid sodas and coffee.

my acne will go away eventually. i don’t know when. but i hope soon.

all i know is i’m no longer going to be obssessed with what i eat as i think that makes acne worse. i’ll just be happy. and accept my acne as part of growing up.

Good points. I don’t mean to say diet affects acne for everyone. I know there are people who get acne no matter how healthy they eat. But it’s equally wrong for dermatologists to keep saying it’s a myth that diet affects acne. Because there is plenty of evidence to show dairy products and high GI foods aggravate acne for some people.

yes, that’s true. diet plays a role in acne, but it’s just sugar really. we tend to consume so much sugar these days, especially the regular table sugar and hfcs. that’s why i avoid flavored drinks and coffee in general…i just drink water.

i eat fairly healthy now…i eat every thing.

if you haven’t tried raw garlic, try it. i do it in the morning, just two cloves of fresh garlic, crushed. this will help you regulate your sugar levels in the body, thus decreasing inflammation. the only thing though is you must take it with an empty stomach because it works better this way.

No, it’s not ‘just sugar’. Sugar and dairy play a part in hormonal-type acne, but they are not the only foods that affect acne. In my case, any foods that cause constipation also lead to acne. So foods like onions, cocoa, strawberries and grapes are out of the question if I want to keep clear skin.

I am going to mail these studies to a dermatologist on whose website was written that diet does not have an influence on acne. Why don’t doctors read scientific research after their graduation ? Shouldn’t that be obligatory ? I always astonished how little the average doctor or med student really knows about disease. All the new research is completely lost at them because it takes so long for new knowledge to be integrated.

You hit the nail in the head. It’s unfortunate that doctors don’t have enough time to keep up to date with research and various medical organizations don’t do a better job at informing them of low risk, low cost options (even if they aren’t fully proven yet).

I remember checking your website about 1.5years ago, and one of your articles about the gut acne axis got me to try a diet based cure.
So after allot of research I diecided the GAPS diet would be the best one and saw a qualified GAPS consultant… So after nearly 2 years of cutting out everything artificial (sugar, dairy, wheat, preservatives, nuts and even fruit) I can report it has worked..

I suffered with acne for over 10years, and now my skin is really good and starting to heal. It took about 12months to start seeing good results though I did see small improvements after 3 months. I still get 1 or 2 little bumps a month though I feel as my gut continues to heal it will be 100%.

The downside…. I basically lived like a hermit for the entire period.. I made every single meal I ate, it was very expensive. Was it worth it? Yes..

I had a question about dairy. I read that home-made yogurt and kefir have drastically lower levels of IGF-1 than regular milk and often don’t aggravate acne whereas milk and cheese are the main culprits. I haven’t been able to find any information about butter and sour cream. Are these generally things to avoid or are they usually not a problem?

During fermentation the bacteria consume a large portion of the IGF-1 in dairy, roughly 75% if I remember correctly. That said, even fermented dairy products (like yogurt and sour cream) spike insulin levels and as such can be very harmful for acne. They might be less harmful than milk but they are far from acne-safe.

Butter is just milk fat and should be ok for acne. It’s the proteins and sugars in dairy that cause the problem.

I’m just a little confused though. Whenever anyone brings up the Kitavan diets, or other islanders who don’t consume a western diet they do so to highlight that a low GI diet is why they stay clear. But, when actually looking into their diet that isn’t the case at all. They eat high GI fruits and tubers. Plantains, sweet potatoes, cassava etc. They make up more than 70% of their diet too. They do eat whole foods though. When asked about this they say that they boil these tubers and therefore it can be called low GI, but even boiled they will still be Med-High GI. And, honestly I doubt they don’t grill since that is easier as they are living. I honestly doubt they have tons of pots around just so they can boil and be low GI.

I live with italians, and mediterranean has lost of fats and carbs too. Yeah not like americans but still carbs, in form of high GI fruit and veggies. And, no they don’t have tons of pots so they can focus on how to minimize GI effect with cooking methods.

I get eliminating, dairy, processed food, grains and beans but I don’t know about the veggies and fruits (High GI) but it annoys me that no one has asked this question? What gives?

I’m not quite sure what you are asking. We can only speculate as to why Kitavan Islanders don’t have acne. My guess is that they have better functioning blood sugar metabolism. It hasn’t been destroyed by years of inactivity and eating too much sugar and processed food. In such situation eating a lot of carbs wouldn’t cause problems as the insulin levels never go too high.

I don’t see a point to eliminate fruits and vegetables, even the high GI ones. More recent science shows GI isn’t really that important. It’s far more important to eat unprocessed real foods than focus on GI.

This article was really interesting. I have always had naturally very oily skin and hair and I sweat a lot as well. The main reason I get acne is due to high levels of testosterone which I can regulate somewhat with birth control ( I now have only mild acne :)). Recently, however, I have begun documenting the differences in my skin between when I live in the UK vs Switzerland (I live in Switzerland for the ski season and the Uk the rest of the time). In the UK I do not eat much dairy,however what little I do it tends to be some-what processed dairy, not full fat. Also while in the UK I eat a lot of of fruit and veg and far less white bread, I mostly eat brown rice for carbs. And yet despite consuming vast quantities of dairy in Switzerland and eating lots of white bread, rosti and pasta I found I was still getting far less acne. Many theories espouse that the main reason dairy is bad is that there are residual hormones left over from factory made dairy products, which I thought might be the reason my acne is better as Swiss dairy is very high quality. I have also found that being at high altitude constantly may influence my acne as well as the atmosphere is generally drier and less wet than at home in the UK. Perhaps the difference is just stress levels, which I have found severely impact my acne. I just wondered if you could offer me any reasons as to why this strange phenomenon happens as I would love to be able to replicate this effect in the UK.

I’m not convinced that natural sugar has a huge effect when it comes to acne. I think it’s important for everyone to reduce their sugar intake in order to lead a healthy life, but you ABSOLUTELY need some sugar in your life.

I’m focusing on eliminating dairy and not because of the sugar content either. I truly believe the culprit is the hormones residing in milk products. Did you know that American cows are milked an average of 300 days a year. Basically, there is a window right before the cow gives birth and right afterwards where they do not milk it, but dairy cows are basically pregnant their entire lives. Not only is it cruel, but just imagine how much stress they must go through and those stress hormones are ending up in the milk we drink. No different then when they slaughter an animal and it suffers right before it passes. The meat taste different, because the animal was producing adrenaline before it passed.

There is 33% more estrogen in cows milk when it comes from a cow that is in it’s last stages of pregnancy. That’s just one hormone. There are hundreds of hormones in cows milk!

They did a study where they compared Mongolian children to American children. Mongolians only milk their cows after they give birth and for a short time after they get pregnant again. Which means there are fewer hormones in their milk. They concluded that American children had far more sex hormones in their system than Mongolian children.

In conclusion, 80% of estrogen in our environment come from milk. Sweden is one of the only countries in the world that has kept records on female menstruation. A hundred years ago, the average age a girl started her cycle was 18! Now, girls are starting at the age of 10, 11, 12…

It’s been proven that girls are maturing faster than they should and boys are actually maturing later than they should because of our environments. We were all taught it’s “normal” for girls to be 3 or 4 inches taller than boys for a year or two. It’s actually not.

Anyhow, do a little research on milk and you’ll see for yourself it’s not AT ALL worth having in your diet.

Nobody has claimed that “natural” sugar will have a huge impact on your skin. But it’s important to realize that your body makes no distinction between natural and processed sugars. It’s all just sugar for the body. Of course, it’s much harder to overeat sugar by eating fruits, and the fiber in them reduces the rate of absorption. On the other hand, fruit juices are just as bad as soft drinks when it comes to sugar.

As to milk, it can cause acne and lead to other health problems. But I’m not convinced it’s because of hormones in the milk. Most probably won’t survive the stomach acid, and if they do survive, not all of them gets absorbed from the gut.

The main issue with milk, that I know of, is the fact that it spikes insulin levels and supplies a lot of leucine. Combined, these two will increase sex-hormone production in the body and possibly lead the effects you described.

For me, caffeine causes acne. I’m not sure if dairy or sugar causes acne for me, because I can have chocolate or fresh chocolate chip cookie dough and not really get a breakout. I realised one day that ever since I was having Starbucks, I started getting bad acne, and I thought it was the milk due to people saying dairy causes acne. So I decided to have coconut milk as a substitute, but I was still getting bad acne. So I stopped having coffee and my skin has cleared up. I still get the occasional pimple because I’m a teenager though.

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